No 9 (2019)

The authors carried out a systematic analysis of the data available in the modern literature on the features of using ultrasound in labor and delivery to determine the position of the fetus, the insertion of the fetal head, the ultrasound signs of a favorable outcome of vaginal delivery and the prediction of surgical delivery. They conducted studies of current protocols for the use of ultrasound in various clinical situations associated with the high probability of developing the clinical mismatch between of the fetal head and the maternal pelvis, obstructed operative vaginal delivery (vacuum extraction, obstetric forceps), as well as the possibilities of evaluating the uterus in the early postpartum period.

The authors have carried out a systematic analysis of the data given in the world literature on the role of the thin endometrium in the aspect of reproductive failures. The review includes the results of studies and metaanalyses published in the PubMed journals on this topic. Modern literature presents various data on the minimum endometrial thickness necessary for pregnancy during the implantation window. The absence of a universal marker of endometrial receptivity and a set of many factors influencing the effectiveness of embryo-endometrial interactions make it difficult to analyze and identify the true causes of reproductive failures in patients with endometrial thinning, which requires further investigations in this area.

The review analyzes the data of modern literature on screening and early and differential diagnosis of epithelial ovarian tumors in the past decade, which are available in relevant databases: Scopus (selections of leading scientific monographs), PubMed, eLibrary (with an expanded access to full-text resources), and the resources of NCCN, ECR, ESUR, and ACR. It summarizes and analyzes the experience of modern medicine and the leading world centers dealing with the problems of combating epithelial ovarian tumors, presents promising studies of screening events, novel diagnostic approaches, and also demonstrates the role of genetic counseling for people at high cancer risk. To solve the currently existing problems associated with the development of effective screening programs and to improve diagnostic methods at all stages of medical examination and treatment are one of the most significant areas in the development of gynecological oncology.

Objective: to investigate the role of the polymorphism of genes involved in vitamin D metabolism in preeclampsia (PE) in women, by justify ing the optimal dose of the vitam in to reduce the risk and severity of PE. Subjects and methods. Examinations were made in 226patients: 30 healthy pregnant women, 35 patients with PE, 131 with high-risk PE, 63 at 14-16 weeks pregnant, and 68 who planned their pregnancy. GC rs2282679, CYP2R1 rs2060793, and VDR rs2228570 were genotyped. DNA was isolated from leukocytes by a PCR assay. Vitamin D intake was estimated from the blood level of 25(OH) D by enzyme immunoassay using the BIOMEDICAGRUPPE kits (Germany). Results. All the women were found to have vitamin D deficiency. In PE and at risk for its development, there was a genotype that did not ensure physiological metabolism of vitamin D. Conclusion. Prescribing vitamin D at a dose of 4000IU to women at high risk for PE at the stage of pregravid preparation and during pregnancy provides a blood D vitamin level sufficient for the favorable course of pregnancy and childbirth.

Aim. To determine risk factors for spontaneous preterm birth in contemporary conditions based on a longitudinal clinical-epidemiological study. Materials and methods. This is a population longitudinal clinical-epidemiological study of 1361 pregnant women residing in the Ivanovo region, who were surveyed at early gestational ages. Of them, 73 and 1288 women had spontaneous premature births and full-term deliveries, respectively. Results. The study findings suggest that a woman’s age, beginning from the age of 25 is a riskfactorfor spontaneous preterm birth. Some of the factors were not conf irmed in our study. We identif ied new factors that increase the risk of spontaneous preterm birth, including a woman’s secondary education, non-use of contraceptives before pregnancy, uterine leiomyoma, and a history of being born prematurely. Conclusion. Our findings on additional risks factor can be used to adjust antenatal care programs to correct modifiable factors.

Objective. To study the experience with robot-assisted surgical interventions performed at the Moscow Regional Research Institute of Obstetrics and Gynecology in 2013 to 2018. Subjects and methods. A total of 594 operations were performed during the reporting period. The patients were divided into 3 groups. Group 1 consisted of patients with benign gynecological diseases (infiltrative endometriosis and recurrent genital prolapse) who had been operated on using the surgical complex. Groups 2 and 3 included patients with obvious morbid obesity and malignant endometrial diseases, who were at high surgical risk. Results. In patients with infiltrative endometriosis, the pregnancy rate was 45.16%, which was comparable with that in the control laparoscopic group. In patients with prolapse, the disadvantage of robotic sacrocolpopexy was only additional time required to install the patient’s console (docking). Anatomical and functional results were comparable with those in the laparoscopic group. In patients with morbid obesity, the complication rate in the robot-assisted laparoscopy group was 3.8%, which was significantly lower than that in the laparoscopic group. Conclusion. Robot-assisted surgery has obvious advantages in the surgical treatment of complex gynecological diseases, not only malignant, but also benign, primarily the concomitant forms of severe infiltrative endometriosis (in certain situations that substantially affect the restoration of reproductive function in the patient).

Objective. To evaluate the impact of anemia during pregnancy in women on the health status of their premature newborns with very low and extremely low birth weight (VLBWand ELBW). Subjects and methods. A one-stage comparative study was conducted at the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology in January 2017 to November 2018. It enrolled 105 women and their premature neonatal infants with VLBW and ELBW, who were divided into 2 groups: 1) VLBW and ELBW babies born to women who had anemia of varying severity during pregnancy (n = 38) and 2) those born to women without anem ia during pregnancy (n = 67). Results. The examined groups of newborns showed statistical differences in gestational age that was 1 week less in Group 1 than in Group 2 (p = 0.004). There were no statistically significant differences in birth weight and height; data on 1 and 5 minute Apgar scores were not obtained in both groups. The death rates were higher in Group 1 than in Group 2; however, there were no statistically signif icant differences (p = 0.093). The frequency of early transfusions of red blood cell and blood components (within the first week of life) was significantly higher in Group 1 babies (p = 0.01). The relative rate of bronchopulmonary dysplasia was higher in Group 1 than in Group 2; there was a tendency towards statistical signif icance of differences (p = 0.06). Comparison of outcomes, such as congenital infection, intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity, and other diseases, revealed no significant differences in Groups 1 and 2. Conclusion. Anemia during pregnancy in women who have given birth to VLBW and ELBW babies is associated with a lower gestational age and with the course of the neonatal period of premature infants, in particular, those with a more frequent need for early blood transfusions.

Objective. To study the indicators of vaginal mucosal innate immunity in the presence of bacterial vaginosis in the first trimester of pregnancy. Subjects and methods. This prospective study enrolled 50pregnant women with bacterial vaginosis. There was a study group of 30 people receiving Tergynan therapy for 10 days and a control one of 20 people having Hexicon therapy for 10 days; their mean age was 31±3.1 and 28±2.4 years, respectively. The investigators conducted a study of vaginal microbiocenosis using PCR (Florocenosis + NCMT tests) and a culture assay for L. crispatus; as well as an immunological analysis of the expression of innate immunity genes, such as Toll-like receptor-9 (TLR-9), tumor necrosis factor-a (TNF-a), and peptide human P-defensin-1 (HBD1), by real-time reverse transcription PCR, and statistical processing (Microsoft Excel 2016 and Statistica 6.1). Results. In the study group, the total bacterial contamination exceeded 7 lg GE/ml; the Lactobacillus titer was 4 lg CFU/ml, as shown by a culture assay; there was a preponderance of L. rhamnosus (73.3%), L. jensenii (40%), and L. crispatus (10%). The microbiological signs of bacterial vaginosis persisted in 30 and 10% of patients after 10 and 30 days of treatment, respectively. Thirty days after therapy termination, there was a 10-fold increase in the titer of Lactobacillus; L. crispatus was found to grow in 60%. The culture assay revealed no Lactobacillus growth in 35% in the control group. L. rhamnosus (75%), L. jensenii (25%), L. crispatus (15%), and L. fermentum (10%) were identified according to the species composition. After 10 and 30 days of treatment, the microbiological signs of the disease persisted in 25 and 45%, respectively. Thirty days after therapy, the Lactobacillus titer reached 6.5 lg CFU/ml; L. crispatus was detected in 55%. Both groups exhibited no significant changes in TNF-a and TLR9 gene expressions. In the study group, the level of HBD1 steadily decreased by 1.7 times from the baseline values; in the control group, the decrease in defensin was short-term and increased at day 30. Conclusion. During the course of treatment, the recurrence rate decreased, normalization of the vaginal microbiocenosis with the growth of protective types of lactobacilli and the balance in the expression of innate immunity factors were noted.

Objective. To determine the current features of the etiology of chronic endometritis (CE) and to justify the need for combination treatment, including local cytokine therapy. Subjects and methods. A total of 128 patients with morphologically confirmed CE underwent determinations of viral and bacterial contamination of the uterine cavity by PCR, the levels of CD16 and CD56 lymphocyte subpopulations and HLA-DRII by an immunohistocytochemical method, and the proinflammatory cytokines TNF-a, IL-6, IL-8, and IFN-y by ELISA. The efficiency of local cytokine therapy with Superlymph was investigated in 30 patients with CE. The indicators were monitored in a group of 25 people without CE. Results. Viruses were found in 62.5% (80/128) of women with CE, which was two times as high as that in the control group (36% (9/25); p = 0.03). Mixed infections were detected in 81.3% (104/128) and 40% (10/25), respectively (p = 0.003). The immunohistochemical signs of CE with an autoimmune component during an exacerbation were observed in 96 (75%) cases; these in the remaining were indicative of remission in CE without an autoimmune component (p < 0.001). There were increases in the levels of proinflammatory factors: 3-fold in TNF-а, 2.7-fold in IL-6, 1.2-fold in IL-8, and 1.4-fold in IFN-y compared with those in the control group (p <0.05). After treatment with Superlymph, there were decreases in the levels of TNF-а, IL-6, and IL-8 by 2.4, 2.9, and 1.2 times, respectively (p <0.01), and IFN-y by 1.8 times (p = 0.04) compared with the pretreatment values. Conclusion. The investigation has revealed the high frequency of viral and bacterial infections in women with CE and an increase in the levels of proinflammatory cytokines. The use of Superlymph reduces the manifestations of the local endometrial inflammatory process and its autoimmune component.

Objective: to evaluate the clinical efficacy of Epigen Intim, 0.1% spray, in patients with vulvovaginitis and/or cervicitis of nonspecific etiology and in those with genital papillomavirus infection (PVI). Subjects and methods. The investigation enrolled 60patients aged 18 to 56 years: Group 1 included 30patients with the clinical and laboratory signs of vulvovaginitis and/or cervicitis; Group 2 comprised 30 patients with PVI and HPV values of> 3 lg DNA copies per 100,000cells. All the patients were prescribed Epigen Intim, 0.1% spray, thrice daily intravaginally; it was additionally used topically in Group 2 patients (with the clinical manifestations of PVI). The treatment cycle for Groups 1 and 2 patients was 10 and 30 days, respectively. Results. After the treatment, there was a significant decrease in the detection rates for the subjective and objective signs of urogenital inflammatory diseases; normalization of leukocyte responses in the vagina (96.7%) and cervical canal (83.3%); reversion of the clinical manifestations of PVI (60.0%); elimination (20.0%) or a decrease in the HPV values to less than 3.0 lg HPV DNA copies per 100,000 cells (26.7%); and an improvement in the cytological examination of cervical scrapings (20.0%). Conclusion. Epigen Intim, 0.1% spray, showed a high efficiency profile in the treatment of urogenital infections and can be recommended as an anti-inflammatory, antiviral and immunostimulating agent for the treatment of vulvovaginitis, cervicitis, and genital PVI.

The menopausal period is characterized by a gradual decrease and then termination of ovarian function, and is also accompanied by various specific symptoms (vasomotor, psychoemotional, vaginal, sexual, etc.) and signs of somatic health problems: loss of bone mineral density, formation of an unfavorable cardiovascular risk profile due to the development of abdominal/visceral obesity, dyslipidemia, endothelial dysfunction, glucose intolerance, as well as impaired psychological status. Postmenopausal mental disorders can occur both as part of menopausal metabolic syndrome (for example, due to relative hyperandrogenism and/or changes in body composition) and as part of an independent nosological entity. Menopausal hormone therapy (MHT) has been recognized as optimal in affecting the symptoms and diseases associated with estrogen deficiency. MHT reduces the severity of vasomotor symptoms and depressive and anxiety disorders and decreases the risk of osteopenia/osteoporosis, some cardiovascular diseases, genitourinary syndrome, and other age-related conditions.

In the article describes treatment options that are most important for the clinician and the efficiency of using a microdose combined oral contraceptive containing drospirenone and active folates for polycystic ovary syndrome. It considers the distinctive features of the drug, a decrease in the severity of adverse drug reactions, and additional positive effects.

Background. Cerebral venous thrombosis is a rare, but life-threatening condition that is now becoming increasingly common in obstetric and gynecological practice due to the widespread use of hormone therapy and assisted reproductive technologies. Description. The paper presents a clinical case of cerebral sinus thrombosis during pregnancy after cryopreserved in vitro fertilization. It analyzes risk factors for cerebral venous thrombosis during pregnancy, the validity of pregnancy management tactics, and the choice of anticoagulant therapy. Conclusion. Cerebral thrombosis can develop in the absence of classical thrombophilia in the presence of antithrombin IIIdeficiency and imbalance in the von Willebrand factor/ADAMTS13system due to hyperestrogenia. Adequately chosen anticoagulant therapy in patients after cerebrovascular thrombosis prevents recurrences, the development of thrombosis of other localizations, and placenta-associated pregnancy complications.

Background. The number of publications on injuries during pregnancy is very small. The prevalence of damage to abdominal organs, except for the uterus, with penetrating abdominal wounds is 19%. Wounds and fetal death are seen more frequently (60-90 and 40-70% of cases, respectively). Abdominal injury-associated obstetric bleedings (46%) are considered to be the leading non-obstetric cause of death in pregnant women; and the fetal death rates due to severe injuries is 61% and reaches 80% if the mother has developed shock. Clinical case report. The paper describes a clinical case of a penetrating stab-and-cut uterine wound with fetal injury and the possibility of performing organ-sparing surgery in a patient with severe hemorrhagic shock, disseminated intravascular coagulation syndrome. Conclusion. The experience with the combined method to arrest obstetric bleeding, which is given in this paper, can be used to treat pregnant women with bleeding associated with abdominal traumas, uterine hypotension, and other causes.